Healthcare Provider Details

I. General information

NPI: 1083372817
Provider Name (Legal Business Name): HORIZON ACADEMY WEST CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 TODOS SANTOS ST NW
ALBUQUERQUE NM
87120-3601
US

IV. Provider business mailing address

3021 TODOS SANTOS ST NW
ALBUQUERQUE NM
87120-3601
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-0459
  • Fax:
Mailing address:
  • Phone: 505-998-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: JOLENE RAEL-BACA
Title or Position: HEALTH ASSISTANT
Credential:
Phone: 505-998-0459